AB1181 INTRAMUSCULAR METHYLPREDNISOLONE ADMINISTRATION IN HAND OSTEOARTHRITIS PATIENTS: A FEASIBILITY STUDY TO INFORM A RANDOMIZED CONTROLLED TRIAL
Authors: M. Hartog, K. Van Keeken, C. Popa, C. Van den Ende
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Inflammation is thought to play an important role in hand osteoarthritis (HOA), which is further associated with pain and increased limitation of hand function [1,2]. Therapeutic options in HOA are scarce [3]. <h3>Objectives</h3> The aim of this study was twofold: to explore the acceptability of treatment with intramuscular (IM) methylprednisolone (MP) in hand OA by both healthcare providers (HCPs) and hand OA patients, and to observe the response to a single IM MP injection in patients with symptomatic hand OA. <h3>Methods</h3> We adopted a mixed methods design. Firstly, in a qualitative study we examined the acceptability of intramuscular MP using questionnaires with open-ended questions for all health care providers of the Rheumatology Department of the Sint Maartenskliniek and a semi-structured interview for an a-selective group of patients with clinically diagnosed hand OA not previously treated with MP. Secondly, in a prospective observational study the course of symptoms was examined in patients with hand OA who received an intramuscular MP injection as part of routine care. Data on average pain and the intensity of pain in the hands and other joints (both assessed on a Numeric Rating Scale), OA related functional impairment (Functional Index of Hand Osteoarthritis questionnaire), use of analgesics and occurrence of adverse events was collected with a checklist within 3 days after the injection was administered (baseline) and at week 4, 8 and 12 after the injection. <h3>Results</h3> Fourteen health care providers (all rheumatologists) and 15 patients (93.3% female, mean age = 67 years) participated in the first part of the study. HCPs considered intramuscular MP therapy as an effective therapeutic intervention and most patients were very open to get this therapy, yet they all expressed their concerns about the risk of long-term adverse events. Twenty-two patients with hand OA participated in the second part of the study. Intramuscular MP administration decreased hand pain with 1.96 (week 4), 1.59 (week 8) and 1.23 (week 12), as compared to baseline (Table 1). The average pain in other joints decreased at 4 weeks after MP administration with 0.73 and at 8 weeks HOA related functional impairment decreased with 2.19, as compared to baseline. A total of 13 patients reported 45 adverse events, of which almost half occurred within the first four weeks after MP administration. <h3>Conclusion</h3> We found a high acceptability of intramuscular MP treatment for hand OA and our findings suggest that methylprednisolone may reduce pain and improve hand function as quick as 4 weeks after administration, with a persisting effect of almost 3 months. This suggests that it might be a valid long-term therapeutic option in these patients. <h3>References</h3> [1]Kortekaas MC, Kwok WY, Reijnierse M, Stijnen T, Kloppenburg M. Brief Report: Association of Inflammation With Development of Erosions in Patients With Hand Osteoarthritis: A Prospective Ultrasonography Study. Arthritis Rheumatol. 2016;68(2):392-7. [2]Kortekaas MC, Kwok WY, Reijnierse M, Watt I, Huizinga TW, Kloppenburg M. Pain in hand osteoarthritis is associated with inflammation: the value of ultrasound. Ann Rheum Dis. 2010;69(7):1367-9 [3]Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases. 2019;78(1):16-24. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.